December 28, 2012
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     I find this block to be one of the few, whether single injection or continuous, where the impact of ultrasound utilization is not as dramatic an improvement as it is with most other nerve blocks. This comes from a few different variables. One, it is usually a deep block, so visualization of structures is on a more gross level of differentiation. Second, it is not as ‘eloquent’ of a block as so many others; we are not placing local exactly between this and that layer or under that structure or between these two nerve roots. With the lumbar plexus block, we are filling a muscle belly with local, so exact guidance of the needle and precise catheter positioning is not as imperative (though clearly, we could choose an inferior needle tip or catheter position). As well, the multiple targets are not immediately adjacent; I know I will likely not be directly ‘on target’ for each nerve root. This is one reason why (among a few) I am not a fan at all of the Axillary Nerve block, especially for catheter placement. Third, I almost hate to admit it, but landmark techniques for this block, I have found, are very good. Most of the time, when I do an out of plane approach with ultrasound, I find that my landmarks would’ve been right on track; it might take me a little longer, but I am on track. After what I’ve written in a lot of other sections on this site, I guess I can’t keep that one.

     The other thing that always lurks in the back of my mind is the question of how much more benefit a patient gets with a Lumbar Plexus block (LPB) nerve block compared to other techniques (like Fascia Iliaca) ) given


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